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Aloi NF, Hyzny R, Fowler JR. Ultrasound Measurements of the Ulnar Nerve at the Medial Epicondyle Correlate With Electrodiagnostic Studies. Hand (N Y) 2024:15589447241259805. [PMID: 38902998 DOI: 10.1177/15589447241259805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
BACKGROUND Cubital tunnel syndrome is the second most common compressive neuropathy in the upper extremity and is commonly evaluated with electrodiagnostic studies (EDS). Ultrasound (US) has emerged as a potentially more efficient alternative to EDS. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the ulnar nerve at the elbow correlate with EDS results. METHODS This study was a prospective analysis of patients who presented with signs and symptoms consistent of cubital tunnel syndrome, who received USs of the ulnar nerve at the elbow and nerve conduction tests. Pearson correlation coefficients were used to evaluate the correlation between ulnar nerve CSA and electrodiagnostic data. t Tests were used to evaluate statistical differences between the mean ulnar nerve CSA of patients with positive or negative nerve conduction study results. Youden Index was used to calculate the optimal cut-off point for US CSA based on maximal sensitivity and specificity. Statistical significance was based on a two-sided P less than .05. RESULTS The association between increasing US CSA at the medial epicondyle with slowing of the conduction velocity of the ulnar motor nerve across the elbow was statistically significant (r = -0.35, P = .02). Patients with positive EDS tests had significantly larger nerve size than those with negative tests (all Ps < .03). A cut-off point of greater than or equal to 11 mm2 had a sensitivity of 70.83% and specificity of 66.67%. CONCLUSIONS Larger ulnar nerve CSAs correlate with slowing of the conduction velocity on EDSs, and those with positive EDSs have larger nerve sizes than those with negative tests.
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Affiliation(s)
- Nicholas F Aloi
- University of Pittsburgh School of Medicine, PA, USA
- University of Pittsburgh Medical Center, PA, USA
| | - Rachel Hyzny
- University of Pittsburgh School of Medicine, PA, USA
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Sheen S, Ahmed A, Raiford ME, Jones CMC, Morrison E, Hauber K, Orsini J, Hammert WC, Speach D. Association between electrodiagnosis and neuromuscular ultrasound in the diagnosis and assessment of severity of carpal tunnel syndrome. PM R 2024. [PMID: 38529791 DOI: 10.1002/pmrj.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Neuromuscular ultrasound plays an increasing role in diagnosing carpal tunnel syndrome (CTS). There are limited data supporting the correlation between the electrodiagnostic studies and ultrasound measurements in CTS. OBJECTIVE To assess the association between different electrodiagnostic severities and ultrasound measurements of the median nerve in CTS. DESIGN A retrospective cohort study. SETTING An academic tertiary care center. PATIENTS Patients 18 years or older evaluated with upper limb electrodiagnostic studies and neuromuscular ultrasound. MAIN OUTCOME MEASUREMENT Ultrasound measurements of the median nerve cross-sectional area (CSA) at the wrist and the calculated wrist-to-forearm ratio (WFR) were compared with the electrodiagnostic severity (normal, mild, moderate, and severe). Mean analysis and analysis of variance test (α = 0.05) were performed to assess the association. RESULTS A total of 1359 limbs were identified. There was a statistically significant association between electrodiagnostic severity of CTS and median nerve CSA at the wrist (p < .001), as well as the WFR (p < .001). The mean median nerve CSA at the wrist and WFR were 7.01 ± 2.06 mm2 (95% CI: 6.80-7.20) and 1.24 ± 0.36 (95% CI: 1.16-1.24) in electrodiagnostically normal median nerves, 10.47 ± 2.82 mm2 (95% CI: 10.25-10.75) and 2.06 ± 0.67 (95% CI: 2.04-2.16) in electrodiagnostically mild CTS, 12.95 ± 4.74 mm2 (95% CI: 12.41-13.59) and 2.49 ± 1.04 (95% CI: 2.37, 2.63) in electrodiagnostically moderate CTS, and 14.69 ± 5.38 mm2 (95% CI: 13.95-15.44) and 2.71 ± 1.02 (95% CI: 2.56-2.84) in electrodiagnostically severe CTS, respectively. CONCLUSION This study suggests a direct association between electrodiagnostic severity and ultrasound measurements of the median nerve in patients with suspected CTS.
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Affiliation(s)
- Soun Sheen
- Department of PM&R, University of Rochester, Rochester, New York, USA
- Department of Pain Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Aabra Ahmed
- Department of Plastic Surgery, University of Rochester, Rochester, New York, USA
| | - Mattie E Raiford
- Department of Orthopedics, University of Rochester, Rochester, New York, USA
| | - Courtney M C Jones
- Department of Orthopedics, University of Rochester, Rochester, New York, USA
| | - Eric Morrison
- Department of PM&R, University of Rochester, Rochester, New York, USA
| | - Kurt Hauber
- Department of PM&R, University of Rochester, Rochester, New York, USA
| | - John Orsini
- Department of PM&R, University of Rochester, Rochester, New York, USA
| | - Warren C Hammert
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - David Speach
- Department of PM&R, University of Rochester, Rochester, New York, USA
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Eberlin KR, Amis BP, Berkbigler TP, Dy CJ, Fischer MD, Gluck JL, Kaplan FTD, McDonald TJ, Miller LE, Palmer A, Perry PE, Walker ME, Watt JF. Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5665. [PMID: 38440365 PMCID: PMC10911521 DOI: 10.1097/gox.0000000000005665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/25/2024] [Indexed: 03/06/2024]
Abstract
Background Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques. Methods In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0-10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year. Results Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (-1.8 versus -1.8; P = 0.96), BCTQ-FSS (-1.0 versus -1.0; P = 0.75), numeric pain scale (-3.9 versus -3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group. Conclusions CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.
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Aloi NF, Rahman H, Fowler JR. Changes in Cross-sectional Area of the Median Nerve and Boston Carpal Tunnel Questionnaire Scores After Carpal Tunnel Release. Hand (N Y) 2024; 19:212-216. [PMID: 36189893 PMCID: PMC10953518 DOI: 10.1177/15589447221127336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We hypothesized that postoperative Boston Carpal Tunnel Questionnaire (BCTQ) scores and ultrasound (US) measurements of the median nerve cross-sectional area (CSA) at the distal wrist crease are significantly decreased at 2-week, 6-week, and ≥ 6 months follow-up appointments, compared with baseline values. METHODS This study was a retrospective chart review of patients who presented to a single hand clinic with evidence of carpal tunnel syndrome over a 6-year period (2014-2020). Patients received baseline US measurements of the median nerve CSA as well as completion of the BCTQ, and for the patients who underwent carpal tunnel release (CTR), postoperative US measurements and questionnaire scores were obtained at 2 weeks, 6 weeks, or ≥ 6 months postoperatively. RESULTS This study included 224 separate wrists. Median Nerve CSA measurements were 13.2 ± 4.5 mm2 at baseline, 11.9 ± 3.6 mm2 at 2 weeks postoperatively, 11.6 ± 4.5 mm2 at 6 weeks postoperatively, and 11.7 ± 4.3 mm2 at 6 months or more (P = .002). The BCTQ Symptom Severity Scale scores were 3.14 ± 0.76 at baseline, 1.76 ± 0.63 at 2 weeks, 1.68 ± 0.70 at 6 weeks, and 1.41 ± 0.64 at 6 months or longer (P < .001). The BCTQ Functional Status Scale scores were 2.56 ± 0.89 at baseline, 2.03 ± .1.0 at 2 weeks, 1.65 ± 0.77 at 6 weeks, and 1.36 ± 0.61 at 6 months or longer (P < .001). CONCLUSIONS These findings demonstrated a sustained decrease in median nerve CSA and patient-reported outcomes following CTR at 2 weeks, 6 weeks, and between 6 and 12 months.
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Affiliation(s)
| | - Haris Rahman
- University of Pittsburgh School of Medicine, PA, USA
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Kimura H, Furuhata R, Matsuo T, Suzuki T, Matsumura N, Sato K, Iwamoto T. Point of care ultrasound combined with CTS-6 to diagnose idiopathic carpal tunnel syndrome. J Orthop Sci 2024:S0949-2658(24)00008-3. [PMID: 38302310 DOI: 10.1016/j.jos.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aimed to demonstrate the effectiveness of our new diagnostic chart using point of care ultrasound combined with CTS-6 for diagnosing idiopathic carpal tunnel syndrome. METHODS We conducted a retrospective analysis of the data of patients who visited our department and received point of care ultrasound combined with CTS-6 from 2020 to 2023. Data regarding age, sex, initial and final diagnosis, cross-sectional area of the median nerve, CTS-6 score, and electrodiagnostic severity were obtained and statistically analyzed. RESULTS Of the 177 wrists included in our study, 138 (78 %) were diagnosed with carpal tunnel syndrome, while 39 (22 %) were not (non-carpal tunnel syndrome). With our diagnostic method, 127 wrists (72 %) were diagnosed initially with carpal tunnel syndrome, 23 wrists (13 %) with non-carpal tunnel syndrome, and the rest 27 wrists (15 %) as borderline. Our initial diagnoses of carpal tunnel syndrome and non-carpal tunnel syndrome were maintained in all cases except for two. Cross-sectional area, CTS-6 score, and electrodiagnostic severity showed a positive correlation. A post hoc analysis showed that the new scoring system (CTS-6 score + 2 × cross-sectional area) with a cutoff value of 31.25 points showed a sensitivity as high as 95 % and a specificity of 100 %. CONCLUSIONS Our findings suggest that most suspected idiopathic carpal tunnel syndrome cases can be diagnosed correctly using the diagnostic chart. Although additional tools, including electrodiagnostic studies, may be needed for borderline cases, the use of point of care ultrasound combined with CTS-6 may be a recommendable first-line confirmatory test because point of care ultrasound and CTS-6 could be complementary tools, and this chart may be especially beneficial for atypical or outlier cases. LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Kitasato Institute Hospital, Tokyo, Japan.
| | - Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Tomoki Matsuo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
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Bohn DC. What's New in Hand and Wrist Surgery. J Bone Joint Surg Am 2023; 105:428-434. [PMID: 36727929 DOI: 10.2106/jbjs.22.01326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Deborah C Bohn
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
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Hirsiger S, Schlimme N, Rossel JB, Christen S, Grobbelaar AO, Vögelin E. The Inlet and Outlet Ratio: Retrospective and Prospective Study on an Improved Diagnostic Ultrasound Tool for Carpal Tunnel Syndrome. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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